| Entity Name: | PEDIATRICS AND FAMILY CARE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 08 Aug 2017 (8 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 29 Sep 2021 (3 years ago) |
| Document Number: | L17000169026 |
| FEI/EIN Number | 82-2410395 |
| Address: | 5150 Curry Ford rd, ORLANDO, FL, 32812, US |
| Mail Address: | 5150 Curry Ford Rd, ORLANDO, FL, 32812, US |
| ZIP code: | 32812 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487162632 | 2018-01-22 | 2024-06-12 | 5150 CURRY FORD RD, ORLANDO, FL, 328128744, US | 5150 CURRY FORD RD, ORLANDO, FL, 328128744, US | |||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||
| Phone | +1 239-600-9389 |
| Fax | 4072864739 |
| Phone | +1 407-286-3653 |
Authorized person
| Name | DR. MARILIZ BORBON BUMGARNER |
| Role | OWNER |
| Phone | 2396009389 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | ME91688 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 271218100 |
| State | FL |
| Issuer | BCBSFL |
| Number | 7VFHM |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PEDIATRICS AND FAMILY CARE LLC 401K PLAN | 2023 | 822410395 | 2024-08-21 | PEDIATRICS AND FAMILY CARE LLC | 7 | |||||||||||||||||||||||
|
||||||||||||||||||||||||||||
| Role | Plan administrator |
| Date | 2024-08-21 |
| Name of individual signing | MARILIZ BUMGARNER |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 4072863653 |
| Plan sponsor’s address | 5150 CURRY FORD RD, ORLANDO, FL, 32812 |
Signature of
| Role | Plan administrator |
| Date | 2024-02-27 |
| Name of individual signing | MARILIZ BUMGARNER |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 4072863653 |
| Plan sponsor’s address | 5150 CURRY FORD RD, ORLANDO, FL, 32812 |
Signature of
| Role | Plan administrator |
| Date | 2022-08-31 |
| Name of individual signing | MARILIZ BUMGARNER |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| BUMGARNER MARILIZ BM.D. | Agent | 5150 Curry Ford rd, ORLANDO, FL, 32812 |
| Name | Role | Address |
|---|---|---|
| Bumgarner Mariliz Dr. | Manager | 5150 Curry Ford Rd, ORLANDO, FL, 32812 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2021-09-29 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2021-09-29 | BUMGARNER, MARILIZ B, M.D. | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-09-18 | 5150 Curry Ford rd, ORLANDO, FL 32812 | No data |
| CHANGE OF MAILING ADDRESS | 2020-09-18 | 5150 Curry Ford rd, ORLANDO, FL 32812 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-09-18 | 5150 Curry Ford rd, ORLANDO, FL 32812 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-12 |
| ANNUAL REPORT | 2023-03-15 |
| ANNUAL REPORT | 2022-04-11 |
| REINSTATEMENT | 2021-09-29 |
| ANNUAL REPORT | 2020-09-18 |
| ANNUAL REPORT | 2019-04-17 |
| ANNUAL REPORT | 2018-06-28 |
| Florida Limited Liability | 2017-08-08 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
